Therapeutic Engagement of Children and Adolescents: Play, Symbol, Drawing, and Storytelling Strategies

191 Pages·2008·5.61 MB·English

by  David A. Crenshaw PhD

Published in the United States of America
by Jason Aronson
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Copyright © 2008 by Jason Aronson
All rights reserved. No part of this publication may be reproduced, stored in a
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British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
Crenshaw, David A.
Therapeutic engagement of children and adolescents : play, symbol, drawing,
and storytelling strategies / David A. Crenshaw.
p. ; cm.
“A Jason Aronson book.”
Includes bibliographical references and index.
9781461632030
1. Child psychotherapy. 2. Adolescent psychotherapy. 3. Therapeutic alliance. 4.
Psychotherapist and patient. I. Title. [DNLM: 1. Child. 2. Psychotherapy—
methods. 3. Adolescent. 4. Professional-Patient Relations. 5. Psychotherapeutic
Processes. WS 350.2 C915t 2008]
RJ504.C75 2008
618.92’8914--dc22
2007042707

Printed in the United States of America The paper used in this publication
meets the minimum requirements of American National Standard for
Information Sciences—Permanence of Paper for Printed Library Materials,
ANSI/NISO Z39.48-1992.
DEDICATION
Olga Silverstein
Olga Silverstein is a beloved, gifted, and innovative family therapist and a
teacher beyond compare. Her wisdom and compassion have informed and
inspired my work and multiple generations of family therapists who were
privileged to take her courses, or workshops, or be supervised by her at the
Ackerman Institute for the Family, where she is presently Faculty Emeritus. Olga
is a master of therapeutic questioning, particularly relational questions, and I
acknowledge a huge debt to her in influencing the development of the relational
questions found in this book. She is also unsurpassed in her ability to explore the
change/stability balance in families and to make explicit the negative
consequences of change, so that the family can make an informed choice. What
a rich legacy her career has left the field of family therapy; what a gift to all of
us who were privileged to learn from her. Olga’s refreshing directness, clinical
incisiveness, verbal facility, knowledge of families, and finely honed family
therapy skills put her in a class of her own. If only there were more like her.
Table of Contents
Title Page
Copyright Page
DEDICATION
1 - Engaging Reluctant Children in Therapy
2 - Relational Strategies to Engage Heart and Mind
3 - The Therapeutic Use of Symbols to Engage Children and Adolescents
4 - Building the Therapeutic Alliance by Honoring Strengths
5 - Strategies to Strengthen the Self-Observer
6 - Facilitating Empathy for Self and Others
7 - Strategies to Access the Pain of Social Rejection
8 - Strategies to Address Grief and Traumatic Loss
9 - The “Quest for Home” Strategies
10 - The Delicate Therapeutic Operation of Facilitating Hope
References
Index
1
Engaging Reluctant Children in Therapy
Overview: Psychotherapy at its best is part science and part art, and I hope it al
ways remains so. Science and empirical research inform and guide clinical
practice but when the child, teen, or family enters the office or therapy room,
what takes place is a unique human encounter that is as much art as science.
One of the crucial tasks in the therapy process is engagement. When children
show up for therapy the therapist is faced with the challenge of engaging what
are typically reluctant participants. For ease of communication, “child” or
“children” will be used in this book to refer to both younger children and
adolescents unless specifically stated otherwise.
Children typically are brought to therapy because someone else-usually a
parent, a teacher, a school official, or a judge—has decided it would be a good
idea for them to get therapy. The children are usually not sold on this idea.
Middle-school children and teens are particularly not convinced of the virtues of
going to therapy. Pre-teens are well-known for viewing the idea of going to talk
to someone about personal problems as alien, if not complete madness. The
therapist, upon arrival of such newcomers, is faced with the challenge to engage
reluctant participants in the therapy process. This book is focused on helping
child and adolescent therapists meet that challenge.
Upon entering the therapist’s office, pre-teens and adolescents fear that the
therapist immediately sees right through them; all their vulnerabilities exposed to
this stranger in this baffling process called therapy. They don’t understand at this
initial point that therapy is a collaborative process; they expect that the therapist
will use psychic X-ray powers to unmask them almost immediately. Others,
because of the coercion used to round them up and herd them into the therapist’s
corral, view the whole process akin to being sent to the principal’s office or
standing before the judge and can’t wait to get the punishment over and the
sentence served. Still others might see some possible value to talking to a trained
professional about issues they are struggling with but are mortified about the
chance that they might be seen by friends coming in or out of the therapist’s
office and thereby branded “a psycho” by their peers. While stigma and shame
associated with seeing a therapist has diminished over recent decades, it is still a
factor for some young people.
Engaging children in psychotherapy typically requires a more proactive and
directive approach than is typical in adult therapy. A positive and hopeful
attitude, emphasizing the strengths of children, and expressing confidence in the
therapy process are essential ingredients (Oetzel and Scherer, 2003; Rubenstein,
1996). The play, storytelling, drawing, and symbol strategies described in
subsequent chapters offer youthful clients from preschool through adolescence a
meaningful, engaging, and (especially for teens) a face-saving way to participate
in therapy. Two decades of empirical research have consistently linked the
quality of the alliance between therapist and client with therapy outcome
(Horvath, 2001). Furthermore, Horvath explained that the magnitude of this
relation appears to be independent of the type of therapy and whether the
outcome is assessed from the perspective of the therapist, client, or observer.
The strategies should not be used as a “cookbook approach” to therapy nor do
they represent a stand-alone approach to therapy. But they have in common the
theme of focusing therapy on the important relationships in the child’s life. They
can be integrated into a wide range of therapy approaches and are especially
compatible with theoretical orientations that give emphasis to interpersonal,
social, and cultural determinants of personality. Relational Therapy is the
orientation that I most closely identify with at this late point in my career,
although I still view myself as Integrative in both theory and therapy rather than
wedded to any one approach. Among the theories that emphasize relational
factors are Relational Theory (DeYoung, 2003); Relational-Cultural Theory
(Miller, 1986; Miller and Stiver, 1997); Relational Psychoanalysis (Mitchell and
Aaron, 1999); Culturalist Psychoanalysis (Bonime, 1989); Family Systems
Theory (Minuchin & Fishman, 1981; Minuchin and Nichols, 1993); Attachment
Theory (Bowlby, 1980); and Interpersonal Neurobiological Theory (Schore
1994, 2003a, 2003b; Siegel 1999, 2007). Magnavita (2006) observes, “The
relational matrix is the ultimate unifying principle of human development and of
psychotherapy. It plays a central role in shaping and influencing human function
and dysfunction” (p. 887).
Since more than two thousand studies (Kazdin, 2005) point to the crucial role
of the therapeutic alliance in psychotherapy outcome research, these strategies
offer a potentially valuable tool to strengthen the therapeutic alliance. It should
be noted that the therapeutic relationship has not been shown to play a causal